Documenting the Contextualization and Implementation of mhGAP-HIG in Post-earthquake Nepal

Background: The burden of mental health is increased in humanitarian settings, and needs to be addressed in emergency situations. The World Health Organization has recently released the mental health Global Action Programme Humanitarian Intervention Guide (mhGAP-HIG) in order to scale up mental health service delivery in humanitarian settings through task-shifting. This study aims to evaluate, contextualize and identify possible barriers and challenges to mhGAP-HIG manual content, training and implementation in post-earthquake Nepal.

Methods: This qualitative study was conducted in Kathmandu, Nepal. Key informant interviews were conducted with fourteen psychiatrists involved in a mhGAP-HIG Training of Trainers and Supervisors (ToTS) in order to assess the mhGAP-HIG, ToTS training, and the potential challenges and barriers to mhGAP-HIG implementation. Themes identified by informants were supplemented by process notes taken by the researcher during observed training sessions and meetings.

Results: Key themes emerging from key informant interviews include the need to take three factors into account in manual contextualization: culture, health systems and the humanitarian setting. This includes translation of the manual into the local language, adding or expanding upon conditions prevalent in Nepal, and more consideration to improving feasibility of manual use by non-specialists.

Conclusion: The mhGAP-HIG must be tailored to specific humanitarian settings for effective implementation. This study shows the importance of conducting a manual contextualization workshop prior to training in order to maximize the feasibility and success in training health care workers in mhGAP.

I Must Do the Post - Using Poetry for Raising Dementia Awareness

This paper reviews the use of a poem written by a care assistant as part of a dementia awareness course. the author of the poem went on to use the poem to help staff within the care home gain an insight and to promote reflection and discussion about caring for the person living with dementia as part of a training programme. an evaluation of its use was a also undertaken and staff reported that this poem was thought provoking, insightful and had helped them to reflect on how they work with people living with dementia.

The art of building trust via e-communication channels: Post-acquisition integration as a special context

This study discusses the importance of establishing trust in post-acquisition integration context and how the use of e-channels facilitates or inhibits this process. The objective of this study is to analyze how the use of electronic communication channels influences the post-acquisition integration process in terms of trust establishment and overall integration efficiency, developing a framework as a result. Three sub-objectives are introduced: to find out the building blocks of trust in M&A’s, to analyse how the use of e-channels influence the process of trust establishment in post-acquisition integration context, and to define the consequences trust and use of e-channels have for the process. The theoretical background of the study includes literature and theories relating to trust establishment in post-acquisition integration context and how the use of e-channels influences the process of trust development on a general level. The empirical research is conducted as a single case study, based on key informant interviews. The interview data was collected between October 2015 and January 2016. Altogether nine interviews were realised; six with representatives from the acquiring firm and three with target firm members. Thematic analysis was selected as the main method for analysing and processing the qualitative data. This study finds that trust has an essential role in post-acquisition integration context, facilitating the integration process in various different ways. Hence, identifying the different building blocks of trust is important in order for members of the organisations to be better able establish and maintain trust. In today’s international business, the role of electronic communication channels has also increased in importance significantly and it was confirmed that these pose both challenges and possibilities for the development of interpersonal trust. One of the most important underlying factors influencing the trust levels via e-communication channels is the level of user’s comfort in using the different e-channels. Without sufficient and meaningful training, the communication conducted via these channels in inhibited in a number of ways. Hence, understanding the defining characteristics of e-communication together with the risks and opportunities related to the use of these can have far-reaching consequences for the post-acquisition integration process as a whole. The framework based on the findings and existing theory introduces the most central factors influencing the trust establishment together with the positive and negative consequences these have for the integration process. Moreover, organizational level consistency and the existence of shared guidelines on appropriate selection of communication channels according to the nature of the task at hand are seen as important

Functional Magnetic Resonance Imaging Neurofeedback and Motor training for Parkinson’s Disease: Randomised Trial

Objective: Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback (NF) uses feedback of the patient’s own brain activity to self-regulate brain networks which in turn could lead to a change in behaviour and clinical symptoms. The objective was to determine the effect of neurofeedback and motor training and motor training (MOT) alone on motor and non-motor functions in Parkinson’s disease (PD) in a 10-week small Phase I randomised controlled trial. Methods: 30 patients with PD (Hoehn & Yahr I-III) and no significant comorbidity took part in the trial with random allocation to two groups. Group 1 (NF: 15 patients) received rt-fMRI-NF with motor training. Group 2 (MOT: 15 patients) received motor training alone. The primary outcome measure was the Movement Disorder Society – Unified Parkinson’s Disease Rating Scale-Motor scale (MDS-UPDRS-MS), administered pre- and post-intervention ‘off-medication’. The secondary outcome measures were the ‘on-medication’ MDS-UPDRS, the Parkinson’s disease Questionnaire-39, and quantitative motor assessments after 4 and 10 weeks. Results: Patients in the NF group were able to upregulate activity in the supplementary motor area by using motor imagery. They improved by an average of 4.5 points on the MDS-UPDRS-MS in the ‘off-medication’ state (95% confidence interval: -2.5 to -6.6), whereas the MOT group improved only by 1.9 points (95% confidence interval +3.2 to -6.8). However, the improvement did not differ significantly between the groups. No adverse events were reported in either group. Interpretation: This Phase I study suggests that NF combined with motor training is safe and improves motor symptoms immediately after treatment, but larger trials are needed to explore its superiority over active control conditions. Clinical Trial website : Unique Identifier: NCT01867827 URL: https://clinicaltrials.gov/ct2/show/NCT01867827?term=NCT01867827&rank=1

Building peace by supporting post-conflict electoral processes

Les élections post-conflit ou élections de sortie de crise organisées sous l’égide de la communauté internationale en vue de rétablir la paix dans les pays sortant de violents conflits armés ont un bilan mixte caractérisé par le succès ou l’échec selon les cas. Ce bilan mitigé représente le problème principal auquel cette recherche tente de répondre à travers les questions suivantes : l’assistance électorale étrangère est-elle efficace comme outil de rétablissement de la paix dans les sociétés post-conflit? Qu’est ce qui détermine le succès ou l’échec des élections post-conflit à contribuer efficacement au rétablissement de la paix dans les sociétés déchirées par la guerre? Pour résoudre cette problématique, cette thèse développe une théorie de l’assistance électorale en période post-conflit centrée sur les parties prenantes à la fois du conflit armé et du processus électoral. Cette théorie affirme que l’élément clé pour le succès des élections post-conflit dans le rétablissement de la paix est le renforcement de la capacité de négociation des parties prenantes à la fois dans le processus de paix et dans le processus électoral post-conflit. Dans les situations post-conflit, une assistance électorale qui se voudrait complète et efficace devra combiner à la fois le processus électoral et le processus de paix. L’assistance électorale sera inefficace si elle se concentre uniquement sur les aspects techniques du processus électoral visant à garantir des élections libres, transparentes et équitables. Pour être efficace, l’accent devra également être mis sur les facteurs supplémentaires qui peuvent empêcher la récurrence de la guerre, tels que l’habilité des individus et des groupes à négocier et à faire des compromis sur les grandes questions qui peuvent menacer le processus de paix. De fait, même des élections transparentes comme celles de 1997 au Liberia saluées par la communauté internationale n’avaient pas réussi à établir des conditions suffisantes pour éviter la reprise des hostilités. C’est pourquoi, pour être efficace, l’assistance électorale dans les situations de post-conflit doit prendre une approche globale qui priorise l’éducation civique, la sensibilisation sur les droits et responsabilités des citoyens dans une société démocratique, le débat public sur les questions qui divisent, la participation politique, la formation au dialogue politique, et toute autre activité qui pourrait aider les différentes parties à renforcer leur capacité de négociation et de compromis. Une telle assistance électorale fera une contribution à la consolidation de la paix, même dans le contexte des élections imparfaites, comme celles qui se sont détenues en Sierra Leone en 2002 ou au Libéria en 2005. Bien que la littérature sur l’assistance électorale n’ignore guère l’importance des parties prenantes aux processus électoraux post-conflit (K. Kumar, 1998, 2005), elle a fortement mis l’accent sur les mécanismes institutionnels. En effet, la recherche académique et professionnelle est abondante sur la réforme des lois électorales, la reforme constitutionnelle, et le développement des administrations électorales tels que les commissions électorales, ainsi que l’observation électorale et autres mécanismes de prévention de la fraude électorale, etc. (Carothers & Gloppen, 2007). En d’autres termes, les décideurs et les chercheurs ont attribué jusqu’à présent plus d’importance à la conception et au fonctionnement du cadre institutionnel et des procédures électorales. Cette thèse affirme qu’il est désormais temps de prendre en compte les participants eux-mêmes au processus électoral à travers des types d’assistance électorale qui favoriseraient leur capacité à participer à un débat pacifique et à trouver des compromis aux questions litigieuses. Cette approche plus globale de l’assistance électorale qui replace l’élection post-conflit dans le contexte plus englobant du processus de paix a l’avantage de transformer le processus électoral non pas seulement en une expérience d’élection de dirigeants légitimes, mais aussi, et surtout, en un processus au cours duquel les participants apprennent à régler leurs points de vue contradictoires à travers le débat politique dans un cadre institutionnel avec des moyens légaux et légitimes. Car, si le cadre institutionnel électoral est important, il reste que le résultat du processus électoral dépendra essentiellement de la volonté des participants à se conformer au cadre institutionnel et aux règles électorales.

Cardiorespiratory fitness and aerobic performance adaptations to a 4-week sprint interval training in young healthy untrained females

Purpose The aim of this study was to test the effects of sprint interval training (SIT) on cardiorespiratory fitness and aerobic performance measures in young females. Methods Eight healthy, untrained females (age 21 ± 1 years; height 165 ± 5 cm; body mass 63 ± 6 kg) completed cycling peak oxygen uptake ( V˙O2V˙O2 peak), 10-km cycling time trial (TT) and critical power (CP) tests pre- and post-SIT. SIT protocol included 4 × 30-s “all-out” cycling efforts against 7 % body mass interspersed with 4 min of active recovery performed twice per week for 4 weeks (eight sessions in total). Results There was no significant difference in V˙O2V˙O2 peak following SIT compared to the control period (control period: 31.7 ± 3.0 ml kg−1 min−1; post-SIT: 30.9 ± 4.5 ml kg−1 min−1; p > 0.05), but SIT significantly improved time to exhaustion (TTE) (control period: 710 ± 101 s; post-SIT: 798 ± 127 s; p = 0.00), 10-km cycling TT (control period: 1055 ± 129 s; post-SIT: 997 ± 110 s; p = 0.004) and CP (control period: 1.8 ± 0.3 W kg−1; post-SIT: 2.3 ± 0.6 W kg−1; p = 0.01). Conclusions These results demonstrate that young untrained females are responsive to SIT as measured by TTE, 10-km cycling TT and CP tests. However, eight sessions of SIT over 4 weeks are not enough to provide sufficient training stimulus to increase V˙O2V˙O2 peak.

A cyber exercise post assessment framework: In Malaysia perspectives

Critical infrastructures are based on complex systems that provide vital services to the nation. The complexities of the interconnected networks, each managed by individual organisations, if not properly secured, could offer vulnerabilities that threaten other organisations’ systems that depend on their services. This thesis argues that the awareness of interdependencies among critical sectors needs to be increased. Managing and securing critical infrastructure is not isolated responsibility of a government or an individual organisation. There is a need for a strong collaboration among critical service providers of public and private organisations in protecting critical information infrastructure. Cyber exercises have been incorporated in national cyber security strategies as part of critical information infrastructure protection. However, organising a cyber exercise involved multi sectors is challenging due to the diversity of participants’ background, working environments and incidents response policies. How well the lessons learned from the cyber exercise and how it can be transferred to the participating organisations is still a looming question. In order to understand the implications of cyber exercises on what participants have learnt and how it benefits participants’ organisation, a Cyber Exercise Post Assessment (CEPA) framework was proposed in this research. The CEPA framework consists of two parts. The first part aims to investigate the lessons learnt by participants from a cyber exercise using the four levels of the Kirkpatrick Training Model to identify their perceptions on reaction, learning, behaviour and results of the exercise. The second part investigates the Organisation Cyber Resilience (OCR) of participating sectors. The framework was used to study the impact of the cyber exercise called X Maya in Malaysia. Data collected through interviews with X Maya 5 participants were coded and categorised based on four levels according to the Kirkpatrick Training Model, while online surveys distributed to ten Critical National Information Infrastructure (CNII) sectors participated in the exercise. The survey used the C-Suite Executive Checklist developed by World Economic Forum in 2012. To ensure the suitability of the tool used to investigate the OCR, a reliability test conducted on the survey items showed high internal consistency results. Finally, individual OCR scores were used to develop the OCR Maturity Model to provide the organisation cyber resilience perspectives of the ten CNII sectors.

Councellors' Experience During Training and Home Based HIV Councelling and Testing in Zomba District, Malawi

Introduction In 2007, St Luke’s Mission Hospital initiated a district-wide Door to Door HIV counselling and testing (HCT) programme in Zomba district. The intent of the programme was to provide quality HCT services to people in their homes and effectively those found to be HIV positive referred to appropriate services. Methodology This was a cross sectional study using a questionnaire consecutively administered to a sample of 105 counsellors who had resided in the community for a period of over one year. The questionnaire sought to establish, knowledge gained, experiences and recommendations on how the programme has been implemented and assist running of similar future programmes. Data analysis was done manually using both qualitative and quantitative methodologies. Results We report that nearly 23% of the counsellors thought that during their training as a door to door HTC councelor they had benefited in learning to working with communities; an aspect they found to be highly applicable in discharge of their duties. The major setbacks during the training were lack daily allowances, less amount of time spent on understanding child councelling and the manual used was diffucult to follow. Over 32% of the councellors were satisfied with the participation of their clients during pre-test counselling sessions, however, the major challenge they had was the misconception that they were blood suckers, a view reported by nearly 17% of the counsellors. Close to 72% reported not to have met any problems during post-test counselling compared to 24% who reported to have found challenges. Conclusion The study has revealed that there is a need to re-look child children counselling especially in training door to door HCT counsellors. It has also revealed the prevalent allowance culture despite the benefits of training. The common challenges were refusal of test Results and failure to understand discordance. Misconceptions may still exist in the community regarding anything dealing with removing blood. There is still need for more information regarding discordance especially among couples in the community.

The Coming of Post-reflexive Society: Commodification and Language in Digital Capitalism

Language is a unique aspect of human communication because it can be used to discuss itself in its own terms. For this reason, human societies potentially have superior capacities of co-ordination, reflexive self-correction, and innovation than other animal, physical or cybernetic systems. However, this analysis also reveals that language is interconnected with the economically and technologically mediated social sphere and hence is vulnerable to abstraction, objectification, reification, and therefore ideology – all of which are antithetical to its reflexive function, whilst paradoxically being a fundamental part of it. In particular, in capitalism, language is increasingly commodified within the social domains created and affected by ubiquitous communication technologies. The advent of the so-called ‘knowledge economy’ implicates exchangeable forms of thought (language) as the fundamental commodities of this emerging system. The historical point at which a ‘knowledge economy’ emerges, then, is the critical point at which thought itself becomes a commodified ‘thing’, and language becomes its “objective” means of exchange. However, the processes by which such commodification and objectification occurs obscures the unique social relations within which these language commodities are produced. The latest economic phase of capitalism – the knowledge economy – and the obfuscating trajectory which accompanies it, we argue, is destroying the reflexive capacity of language particularly through the process of commodification. This can be seen in that the language practices that have emerged in conjunction with digital technologies are increasingly non-reflexive and therefore less capable of self-critical, conscious change.